Childhood cancer survivors (CCS) have significantly elevated risk of premature mortality and serious morbidity due to chronic health conditions developed at a young age. Cancer treatment has been associated with long- term chronic health conditions in CCS, including increased risk for cardiac and endocrine morbidities. Nutrition plays an important role in the etiology of chronic health conditions, and is among the few modifiable behaviors that can prevent or delay the early onset of chronic diseases. Patterns of poor nutritional intake may significantly exacerbate these morbidities in CCS, while healthy dietary patterns may serve as a protective function. Identifying nutritional patterns in young adul CCS is clearly a major priority for improving the survival and long-term health of this population. However, the nutritional intake in adult survivors of childhood cancer has not been adequately studied. In particular, the long-term impact of cancer diagnosis and treatment on the nutritional intake in CCS has not been established. How survivors' nutritional intake is associated with chronic health conditions have not been well quantified in large-scale studies. This application addresses these major gaps in knowledge by means of two specific aims. First, we will evaluate the associations between cancer- and treatment-related factors and nutritional intake in more than 2,500 adult survivors of childhood cancer (mean standard deviation for age = 32.3 8.3 years) enrolled in the St. Jude Lifetime (SJLIFE) cohort. We will evaluate survivors' diet quality using indices that assess adherence to the 2010 Dietary Guidelines for Americans (HEI-2010 & AHEI-2010), the Dietary Approaches to Stop Hypertension (DASH) diet, and the Mediterranean (aMED) diet. We will also empirically derive dietary patterns that assess a broad picture of food and nutrient consumption in CCS. In addition, we will examine the dietary intake of key nutrients and food groups and the use of dietary supplements in CCS. Second, we will describe whether survivors' nutritional intake is associated with the prevalence of chronic health conditions ascertained based on systematic and comprehensive medical assessment. We will first evaluate whether survivors' nutritional intake is associated with cardiometabolic risk factors (hypertension, dyslipidemia, insulin resistance or diabetes, and obesity), and the prevalence of chronic health conditions (cardiovascular, pulmonary, endocrine or reproductive condition, and secondary neoplasm). Subsequently, we will examine whether CCS at risk by treatment exposure experience the associations between nutrition and health differently from those not at risk, with risk defined based on the Children's Oncology Group (COG) long-term follow-up guidelines. Although cross-sectional in nature, our study will provide the first large-scale evidence on the nutritional intake of CCS in young adulthood. These highly relevant findings will inform the design of longitudinal studies and nutrition intervention trials to improve the survival and long-term health of CCS.